Permission

Posted by MDViews on December 11, 2008

Mrs. Smith (fictitious name) comes in for her first prenatal visit at about 8 weeks. Our practice performs a routine ultrasound at the first visit. When the baby appears on the ultrasound monitor, I point out the parts that can be seen, especially the heart motion.

“Isn’t that wonderful?” I say. “That’s your baby, your son or daughter, growing inside you right now.” Then, the baby will move, as usually happens. The arm and leg buds wiggle, the torso moves back and forth. The obvious movement surprises and sometimes startles the soon-to-be mom and dad.

“The baby is moving!” she exclaims.

I look up and see tears forming in her eyes. The reality of this new life floods the room. I feel nothing but awe.

“So, have you felt the baby move?” I ask Mrs. Jones (fictitious name) matter-of-factly at her 20 week prenatal visit.

“Yes, I have. For about two weeks now, I think,” she replies.

I smile. “What do you think about that?” I ask.

“Oh,” she smiles back. “It’s wonderful. I always wondered what it would feel like. It’s nothing like I thought it would be.”

“Being a man, I have no idea what the feeling is,” I answer. “But I have to think it would be very special. To just know that there is a new life, a new person, a child who will possibly have you or your husband’s hair color, features, temperaments, eyes—all that. And there it is. Growing and moving inside you. You are a walking miracle.”

By now, I can see a thoughtful expression, often a smile and agreement.

For an obstetrician such as myself, prenatal care is a conversation about the medical and social aspects of pregnancy, all of which need to be covered and all of which need their appropriate attention. In fact, we have huge lists of what to cover each visit. Things like clinic procedures, HIV counseling and testing, nutrition, weight gain, seat belts, exercise, prenatal screening and diagnosis, smoking, alcohol, drugs, overheating, cats, raw meat, un-pasteurized milk—and that’s just the first trimester.

It’s an exam each visit, usually not involved, of weight, blood pressure, fetal heart tones, growth, position and edema.

It’s a phone call in the middle of the night, attention during labor, monitoring the patient and the baby, pushing, sweating, delivering, resuscitating, bleeding and repairing.

It’s a medical-legal risk, a worry, a burden and another day working sleep-deprived.

And that’s just the routine ones.

Most often for a woman (I have seen exceptions), pregnancy and childbirth culminate a life-long dream, a dream she’s had since she was 9 years old. She has listened attentively to pregnancy stories through her growing-up years. She’s ooh-ed and ahh-ed over newborns. She has looked at a boyfriend and wondered what her baby would look like if he were the father. She’s wondered if she would be fertile, what pregnancy would be like, if she would be able to handle labor and delivery and if she’d be a good mom.

In my 30+ years of attending pregnancies and childbirth, I’ve noticed a change. A not-so-subtle change. Society seems to pressure women into a view of marriage, pregnancy and family that stifles joy and excitement and honor. From a girl, a career for her dominates the conversation and teaching. One view holds sway—career fulfills and motherhood burdens. The adequacy, even superiority, of day-care compared to mom-care goes unquestioned. Statistics about the cost of children frighten the most well-to-do. Magazines write articles about tummy tucks and breast lifts for those sorry pregnancy and nursing changes in a woman’s form. Population experts proclaim a goal of none or one, two children at the max and upbraid those women who would add another carbon footprint to our world, an irresponsible act.

So, a woman presents for prenatal care with measured excitement, suppressed joy and worried happiness. But she carries the excitement, the joy and the happiness just beneath the surface; these feelings even, sometimes, a surprise to her. The heart beats on ultrasound—how wonderful! The tummy starts showing—has anyone noticed? The baby moves—what a bond you now have to the baby and to mothers everywhere who have felt the same. The birth is approaching—how are your preparations going at home? Did you take classes? How does your husband feel about being a father? What color hair do you think the baby will have? Uncomfortable toward the end—it means you are that much closer to motherhood, holding your baby, looking into your baby’s eyes, showing your baby to your own mom, a special moment.

Permission. That’s what I try to give to my pregnant patients. Permission to be joyful. Permission to realize the miracle occurring inside them. Permission to have awe over the heartbeat and ultrasound and movement and even the changing pregnant form. Permission to glory in the entire experience, the magnificent process of conceiving new life, nurturing new life, carrying new life, bringing forth new life and then holding, cuddling and loving that new life, that baby, that child.

It’s not hard. The feelings are already there. They just need permission to come out.

Pregnancy in 2008 is a 59400, a SUPERVIS NORMAL 1ST PREG[V.22], a 12-14 prenatal visits, two ultrasounds, one normal delivery and one routine postpartum visit event.

What is the ICD-9 (International Classification of Disease) code for “MIRACLE?”